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A Systematic Review and Meta-analysis of the Effect of Gastric Bypass Surgery on Plasma Lipid Levels

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Abstract

Background

Obesity-related dyslipidaemia comprises hypercholesterolaemia, hypertriglyceridaemia, low HDL-cholesterol and normal to raised LDL-cholesterol levels. 40 % of morbidly obese surgical patients have dyslipidaemia. Roux-en-Y gastric bypass (RYGB) surgery has many beneficial metabolic effects, but the full impact on plasma lipids has not been clearly defined.

Methods

A systematic review of electronic databases (Ovid; Medline; PubMed; Embase) between 1960 and March 2012 was performed using search terms including the following: obesity surgery, bariatric surgery, gastric bypass, cholesterol, lipids, triglycerides and non-esterified fatty acids. A total of 2442 manuscripts were screened. Papers with paired plasma lipid levels around RYGB surgery were included. Exclusions included the following: editorials, dual publications, n < 10, resulting in 75 papers of relevance. A meta-analysis was performed of the effect of RYGB surgery upon plasma lipids at different time points up to 4 years following surgery, using a random effects model.

Results

Paired data were available for 7815 subjects around RYGB surgery for morbid obesity with a baseline BMI 48 kg/m2 (n = 2331). There was a reduction in plasma total cholesterol and LDL-C from 1 month up to 4 years post-RYGB (p < 0.00001, p < 0.00001). Following RYGB, HDL-C increased from 1 year onwards (p < 0.00001), and triglyceride levels were reduced postoperatively from 3 months up to 4 years (p < 0.00001). NEFA levels were increased at 1 month postoperatively (p = 0.003), but from 3 months onwards did not differ from preoperative levels (p = 0.07).

Conclusions

RYGB surgery reverses the dyslipidaemia of obesity. These findings support the use of RYGB in the management of high cardiovascular risk lipid profiles in morbid obesity.

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Abbreviations

AT:

Adipose tissue

BA:

Bile acid

BMI:

Body mass index

GIP:

Gastric inhibitory polypeptide

GLP-1:

Glucagon-like peptide 1

HDL-C:

High-density lipoprotein cholesterol

IR:

Insulin resistance

LPL:

Lipoprotein lipase

LDL-C:

Low-density lipoprotein cholesterol

NEFA:

Non-esterified fatty acids

PYY:

Peptide tyrosine-tyrosine

RYGB:

Roux-en-Y gastric bypass

SMD:

Standard mean difference

TG:

Triglycerides

T2DM:

Type 2 diabetes mellitus

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Authors and Affiliations

  1. Department of General Surgery, King’s College Hospital, Denmark Hill, London, UK, SE5 9RS

    Kirstin A. Carswell, Ajay P. Belgaumkar & Ameet G. Patel

  2. Division of Diabetes and Nutritional Sciences, King’s College London, London, UK

    Kirstin A. Carswell & Stephanie A. Amiel

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  1. Kirstin A. Carswell
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Carswell, K.A., Belgaumkar, A.P., Amiel, S.A. et al. A Systematic Review and Meta-analysis of the Effect of Gastric Bypass Surgery on Plasma Lipid Levels. OBES SURG 26, 843–855 (2016). https://doi.org/10.1007/s11695-015-1829-x

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